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Are Patients Cared for Equally? Challenges of the VIP Patient

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Do you feel defensive, resentful and uneasy when told you will be caring for a “very important patient (VIP)”? Have you been caught off guard when asked to treat a VIP differently from your other patients? This article with explore the challenges and consequences of “VIP Syndrome”.

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Are Patients Cared for Equally?  Challenges of the VIP Patient

Have you ever been given a patient assignment and hear the words "You have a VIP"? I cringe when I am assigned the Very Important Patient (VIP)- a.k.a. Very Influential and Very Intimidating Patient. My resentment begins to bubble over and I find it offensive that I am expected to treat one patient "better" than another. I also resent the additional pressure from my supervisor, administration and the VIP. I have never cared for a famous celebrity, but I have witnessed the effects of VIP syndrome when caring for local politicians, CEOs, influential and local celebrities. Although nurses do care for high profile celebrities, this article will focus on the more frequently occurring local VIPs.

What makes an individual a VIP? Any patient whose status has the potential to influence the judgment and care of healthcare providers is a VIP patient. The first VIP image to pop into my mind is the national celebrity. However, this article will focus more on VIP status due to occupation, position or social status. Common VIPs may include hospital administrators, physicians, local athletes and any patient with influence. The ethical and moral issues surrounding the care of a VIP is often referred to as "VIP Syndrome" and results in care that can be of greater or lesser quality. Let's take a closer look at common ethical issues that surface when treating a VIP.

Social Justice

The principle of social justice implies patients will be treated fairly and with equal distribution of access to care and resources. Providing preferential treatment is often a difficult, if not impossible, pill for a nurse to swallow. V.I.P. treatment deviates from the nursing code of ethics of approaching all patients with the same level of attention and care regardless of social status. VIP Syndrome challenges the principle of social justice by resulting in greater access, attention and resources from healthcare providers, including nurses. Examples include:

  • Schedules adjusted to accommodate physician appointments, consults, diagnostics and treatment
  • Decreased waiting times (MD office, emergency department, hospital call light)
  • Access to additional resources (diagnostics, specialists, equipment, transportation)

When providing VIP treatment, the healthcare team often steers away from standard practices, protocols, policies and procedures. Therefore, care surrounding the VIP often becomes chaotic and pulls resources away from other patients.

Autonomy

Autonomy is the right patients have to make informed decisions about their medical care independently without the healthcare provider attempting to influence their decisions. Therefore, patients have the right to receive clear information and education regarding care so that an informed decision can be made. Let's look at a case study:

Mr. Jones is a well-known local meteorologist on a popular morning news program. Mr. Jones fell at home and presents to the emergency department with a broken femur. The triage nurse notes a strong odor of alcohol from the patient. The nurse does not want to embarrass Mr. Jones, therefore, does not complete a thorough history or physical. The physician, not wanting to upset the patient, does not determine if alcohol was a contributing factor in the fall. The patient is impatient and to avoid inconvenience, minimal lab work is ordered.

In this scenario, only a limited patient history and assessment is performed to avoid inconveniencing the patient. The VIP will be asked to make decision regarding treatment, but does not have the benefit of a thorough assessment. The patient's drinking habits are not explored,therefore, the patient will not have the opportunity to make decisions on participating in an alcohol protocol.

Healthcare providers often deviate from standard practices and protocols. Breaking rules when treating VIPs occurs when staff do not want to inconvenience, cause anxiety or tell the patient (or family) "no". This deviation places the VIP at risk for lower care quality and substandard outcomes (Alfandre, 2017)

Privacy

Privacy often becomes an issue for VIP patients. In my career, I have been tempted to share details a VIP's situation and had to make a conscience effort to maintain confidentiality. Staff may bend rules safeguarding privacy and share details of the VIPs situation to other staff or individuals outside of the hospital. To protect privacy, high profile patients may be moved to a more secure area of the hospital.

Tips for Care of the VIP

In 2011, The Cleveland Clinic published "Caring for VIPs: Nine Principles" to address the challenges of VIPs. Although the principles are geared towards physicians, the article provides several "takeaways" for nurses.

  • Do not bend rules. Provide care with effective clinical judgement and practices congruent with standards of practice and the institution's policies and procedures.
  • Work as an interdisciplinary team and communicate frequently.
  • Avoid assigning only certain nurses to care for the VIP. This will help to maintain the usual flow of care.
  • Always protect the patient's confidentiality and follow your institutions policies and procedures regarding communication with media.
  • Be careful about accepting or declining gifts. Speak with a supervisor if questions regarding gifts.

Caring for VIPs brings the potential of ethical dilemmas to healthcare providers. Being aware of common challenges will help to reduce pressure and frustration when assigned a VIP. What challenges have you personally experienced? What tips would you like to share with readers?

Supporting Literature:

David Alfandre et at. Caring for "Very Important Patients" -Ethical Dilemmas and Suggestions for Practical Management. Am J Med. 2016:129:143-147.

Gusman et al. Caring for VIPs: Nine Principles. Cleve Clin J Med. 2011:78(2):90-94.

Davis, M. Do You Know Who I Am? Treating a VIP Patient. BMJ 2016:358:i2857.

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RN, MSN with over 20 years nursing experience. Worked in a variety of settings- from bedside nursing to leadership and nursing faculty.

5 Likes, 4 Followers, 19 Articles, 23,106 Visitors, and 162 Posts.

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I refuse to prioritize someone simply because they're wealthier than the patient next to them, despite recommendations to do otherwise. They become so accustomed to special treatment that being told they'll have to wait for something is a complete shock to their system. The entitlement and constant demands wear on me. Should I lose my job or be penalized somehow for treating everyone equally, so be it. I grew up homeless and wouldn't want someone putting me last on their priority list because of that. It's completely unethical despite the norm.

To answer your questions though, the challenges I face are these entitled "VIP" patients constantly hitting the call light and having family members flag random staff down if we're not there at the snap of their fingers to address something non-urgent. Their wealth and status has them completely out of touch with reality and unconcerned with the time constraints us peon nurses are facing. They're much more likely to complain to management, so my suggestion is to contact your manager if you get any inkling of any idea that your entitled patient is nearing their inevitable meltdown over something benign. They'll appreciate the heads up. Lastly, I'd suggest rotating nurses as usual, however, avoid assigning your newer nurses to these patients. They'll often consume more time throughout your shift than 2 rapid responses so assigning nurses with top time management skills is key. If you have supportive management, that may be less of an issue.

FYI, I'm saying this as a newer nurse living in a very wealthy area. Catering to politicians and celebrities was included in our orientation and I'd highly recommend avoiding working for boutique hospitals in these types of areas. Burn out could not have been escalated faster for me. God speed.

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Hospital. Board. Member.

AKA: battle axe,

-reminds everyone she used to run the joint, taught half the staff back in tha day

I'm sorry, but I'm giving that lady some damned R-E-S-P-E-C-T. Now if I have a pt crashing next door and she wants ice chips, she'll wait. But I betcha she already knows that. Please refer back to: "she used to run the joint"

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I worked in a hospital that had VIP patients. The first time I heard that I was getting a VIP I though it was a joke, after a laughed a little I was told it was not a joke but real. I was shocked. I was not a young person at this time so already been around the block a few times. I was just surprised that this Christian hospital would do such a thing. I told my MN that I though we, as nurses/healthcare professionals were supposed to treat everyone the same, he didn't say anything, again I said I thought God (my boss was Christian and also knew that I was too) tells us that we are all the same, again nothing. I know he didn't have any say so either, but I was just surprised and upset about it. We didn't have regular room already set up for VIP's so they just transformed a regular patient room to make it VIP, couch, chair, lamp, refrig, micro etc. etc. At that time the nurse would usually have that 1 patient (maybe 2). It was ridiculous to me to have to cater to these patients like that. Not all were idiots, some even seemed a little embarrassed (as they should). As for the politicians mentioned by the above poster, maybe if they had to receive healthcare in the same way the rest of us do they might actually do their job and try to fix it (but I wont be holding my breath). I never would, or did, not provide appropriate and timely care to anyone (VIP or not) based on social status. All patients should receive prioritized care based on need and that is what they always got from me.

Thanks for the great article!

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Daisy4RN said:
I worked in a hospital that had VIP patients. The first time I heard that I was getting a VIP I though it was a joke, after a laughed a little I was told it was not a joke but real. I was shocked. I was not a young person at this time so already been around the block a few times. I was just surprised that this Christian hospital would do such a thing. I told my MN that I though we, as nurses/healthcare professionals were supposed to treat everyone the same, he didn't say anything, again I said I thought God (my boss was Christian and also knew that I was too) tells us that we are all the same, again nothing. I know he didn't have any say so either, but I was just surprised and upset about it. We didn't have regular room already set up for VIP's so they just transformed a regular patient room to make it VIP, couch, chair, lamp, refrig, micro etc. etc. At that time the nurse would usually have that 1 patient (maybe 2). It was ridiculous to me to have to cater to these patients like that. Not all were idiots, some even seemed a little embarrassed (as they should). As for the politicians mentioned by the above poster, maybe if they had to receive healthcare in the same way the rest of us do they might actually do their job and try to fix it (but I wont be holding my breath). I never would, or did, not provide appropriate and timely care to anyone (VIP or not) based on social status. All patients should receive prioritized care based on need and that is what they always got from me.

Thanks for the great article!

Wow! My experience was in the ED. No special room down there!! Love your statement on politicians getting real healthcare Tx. Please let me get one because I'm pretty my hospital doesn't have mini-fridges anywhere. lol!!

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I once cared for a congressman's mother. She was one of the sweetest patients I have ever had the privilege of caring for. I didn't know who she was till the CMO and all the heads of departments were visiting her. It was obvious none of it went to her head. On the other hand, you could tell that her congressman son was used to getting that treatment.

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So glad I work in the public system in Australia. Saying that I had the mother of the premier of the state as a patient and didn't know until the CEO rocked up to thank us for our care as she had great feedback from him. She was in a 3 bed room, ancient hospital and tiny!

The VIPs I usually get are high profile prisoners that are too unwell for the prison ward at the hospital that has the contract.

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My hospital actually has at least one VIP that could possibly need us every so often. It would scare me to be assigned to this person, but would give the same, great care I give to all my patients. I would just be aware I'd be under more scrutiny.

The extra scrutiny is the scary part.

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Lankenau Hospital, flagship hospital of Main Line Health, next door to Philadelphia, PA has created The Barbara Brodsky Suites "A distinctive option in private accommodations."

Quote
When you're resting in a spacious suite all your own, it's easy to forget you're in a world-class hospital. Our suites feature stylish living and dining areas, elegant bathrooms and personalized concierge services. With plenty of room for visitors and the finest in personal amenities, the Barbara Brodsky Suites provide an inviting space specially designed for your well-being and comfort.

Amenities and features

Concierge services

Daily newspaper delivery

Reception area with electric fireplace, TV and refreshments

Dining area with sink and refrigerator stocked with beverages and snacks

À la carte transportation, salon and notary services

Business center with workspace and computer

Valet parking

Afternoon tea service

Senior and junior suites

Fine linens

Designer living room

Ultra-soft socks, pajamas and robe

60" flat screen TV

Large windows with motorized shades

Comfortable sleeper sofa for visitors

Large wardrobe with lock

Gourmet meals through Distinctive Dining

Towel warmer, fogless makeup mirror and grand vanity

Heated reclining massage chair

En suite bathroom

Deluxe toiletries

Reserve your spot today

Junior Suites: $400/night

Senior Suites: $500/night

Patients/Clients are hospitalized due to the need for NURSING CARE.

Successful patient outcome depends on vigilance and competent knowledge base of professional staff. Above extras have no effect on patient surviving hospital stay.

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Serhilda said:
I refuse to prioritize someone simply because they're wealthier than the patient next to them, despite recommendations to do otherwise. They become so accustomed to special treatment that being told they'll have to wait for something is a complete shock to their system. The entitlement and constant demands wear on me. Should I lose my job or be penalized somehow for treating everyone equally, so be it. I grew up homeless and wouldn't want someone putting me last on their priority list because of that. It's completely unethical despite the norm.

To answer your questions though, the challenges I face are these entitled "VIP" patients constantly hitting the call light and having family members flag random staff down if we're not there at the snap of their fingers to address something non-urgent. Their wealth and status has them completely out of touch with reality and unconcerned with the time constraints us peon nurses are facing. They're much more likely to complain to management, so my suggestion is to contact your manager if you get any inkling of any idea that your entitled patient is nearing their inevitable meltdown over something benign. They'll appreciate the heads up. Lastly, I'd suggest rotating nurses as usual, however, avoid assigning your newer nurses to these patients. They'll often consume more time throughout your shift than 2 rapid responses so assigning nurses with top time management skills is key. If you have supportive management, that may be less of an issue.

FYI, I'm saying this as a newer nurse living in a very wealthy area. Catering to politicians and celebrities was included in our orientation and I'd highly recommend avoiding working for boutique hospitals in these types of areas. Burn out could not have been escalated faster for me. God speed.

Thanks for the suggestions. I look back and as a new nurse, I did not have the "tools" experience brings to not take the behaviors of VIP personally.

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K+MgSO4 said:
So glad I work in the public system in Australia. Saying that I had the mother of the premier of the state as a patient and didn't know until the CEO rocked up to thank us for our care as she had great feedback from him. She was in a 3 bed room, ancient hospital and tiny!

The VIPs I usually get are high profile prisoners that are too unwell for the prison ward at the hospital that has the contract.

I enjoyed reading your perception and experience living in Australia.

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NRSKarenRN said:
Lankenau Hospital, flagship hospital of Main Line Health, next door to Philadelphia, PA has created The Barbara Brodsky Suites "A distinctive option in private accommodations."

Patients/Clients are hospitalized due to the need for NURSING CARE.

Successful patient outcome depends on vigilance and competent knowledge base of professional staff. Above extras have no effect on patient surviving hospital stay.

A great follow up article topic would be concierge services as above. Thanks!

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